Venus Freeze Consent Form Venus Freeze Consent Form I hereby authorize a Treatment Professional and/or such assistants as may be selected to perform the following procedure and/or treatment: Venus Freeze I understand that there is a possibility of short-term side effects from the Venus Freeze treatment. I could experience edema (swelling), prolong redness in the area treated, as well as slight heat discomfort/tingling.Side Effects Consent* These side effects have been fully explained to me during my consultation/treatment. I acknowledge that patient results may vary depending on many factors including, but limited to, medical history, and individual’s response to treatment; patient compliance with pre and post treatment instructions or changes in medical condition prior to, during or after treatment has been completed. I agree (if required/requested) to the photographing of appropriate portions of my body for medical, scientific or educational purposes, provided they do not reveal my identity. I understand that the Venus Freeze treatment protocol involves a series of treatments with a specific protocol involved along with a fee structure associated to this series.Treatment Protocol Consent* I agree to follow this treatment protocol and fee structure as it was explained to me. Name* First Last Date* Date Format: MM slash DD slash YYYY LocationLocationPitt MeadowsPort MoodyELECTRONIC CONSENT*AGREEDISAGREEELECTRONIC CONSENT: Please select your choice below. Clicking on the "agree" button below indicates that: • I have read and fully understand this agreement and all information detailed aboveSignature*Treatment Consent* I CONSENT TO THE TREATMENT OR PROCEDURE AND THE ABOVE LISTED ITEMS. I AM SATISFIED WITH THE EXPLANATIONS GIVEN.
